Management Strategies for Graves’ Disease in Children: Current and Future Perspectives

Abstract

Graves’ disease is the leading cause of hyperthyroidism in children, characterized by an autoimmune process that stimulates excessive thyroid gland activity. Although less common in children than in adults, the disease can significantly impact their physical and psychological development. Currently, three primary treatment strategies for pediatric Graves’ disease include antithyroid drugs (ATDs), radioactive iodine (RAI), and thyroidectomy. Antithyroid drugs can be administered using different medications, dosages, and approaches, with methimazole considered the first-line therapy due to its relative safety and effectiveness. However, they are associated with a low remission rate and a high risk of relapse. RAI is used more cautiously in younger children due to concerns over potential long-term effects on growth and development. Meanwhile, thyroidectomy, typically performed as a total thyroidectomy, offers a definitive treatment but carries risks of complications, including damage to the recurrent laryngeal nerve or hypoparathyroidism. Future prospects focus on targeted and personalized therapies that directly address the underlying pathogenesis of the disease. Novel treatments are exploring monoclonal antibodies that specifically target molecules such as the thyroid-stimulating hormone receptor (TSHR) or associated cytokines, aiming to modulate the autoimmune response. Additionally, immune-modulating therapies that regulate B-cell activity and mitigate autoimmune reactions are under development. These potential therapeutic strategies aim not only to enhance treatment efficacy but also to minimize adverse effects, laying the foundation for improving the quality of life for children with Graves’ disease.